From the Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine.
Plast Reconstr Surg. 2023 Feb 1;151(2):200e-206e. doi: 10.1097/PRS.0000000000009827. Epub 2022 Nov 8.
Several clinical studies have reported autologous breast reconstruction (ABR) to be associated with a higher postoperative complication rate; however, few have investigated the impact of reconstructive modality on complication severity. This study examines the impact of reconstructive modality on complication severity in a matched cohort of patients who underwent ABR versus implant-based breast reconstruction (IBR).
A retrospective study of patients who underwent nipple-sparing mastectomy with immediate reconstruction was performed. Propensity score matching ensured adequate matching of patients who underwent ABR and staged prepectoral IBR, respectively. Patient demographics, breast measurements, and postoperative outcomes (including the incidence and severity of complications) were analyzed. Multivariable logistic regression analysis was performed. P < 0.05 was considered significant.
One hundred twenty-eight patients (214 breast reconstructions) were included for analysis (ABR, n = 64; IBR, n = 64). No difference in overall complication rate was noted ( P = 0.61). However, a significant association of IBR with major complications was noted ( P = 0.02). In contrast, minor complications were significantly more frequent following ABR ( P = 0.04).
Although the reconstructive modality did not appear to have an effect on the overall complication rate, it did significantly affect the severity of postoperative complications, with major and minor complications being associated with IBR and ABR, respectively. These findings are relevant to patient-centered decision-making, as they provide further granularity regarding postoperative complications and address the issue of complication severity.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
几项临床研究报告称，自体乳房重建（ABR）术后并发症发生率较高；然而，很少有研究探讨重建方式对并发症严重程度的影响。本研究调查了在接受 ABR 与基于植入物的乳房重建（IBR）的匹配队列患者中，重建方式对并发症严重程度的影响。
对接受保留乳头的乳房切除术即刻重建的患者进行了回顾性研究。倾向评分匹配确保了接受 ABR 和分期前胸肌内 IBR 的患者充分匹配。分析了患者的人口统计学、乳房测量值和术后结果（包括并发症的发生率和严重程度）。进行了多变量逻辑回归分析。P<0.05 为有统计学意义。
共纳入 128 例患者（214 例乳房重建）进行分析（ABR，n=64；IBR，n=64）。总并发症发生率无差异（P=0.61）。然而，IBR 与主要并发症显著相关（P=0.02）。相反，ABR 后小并发症明显更常见（P=0.04）。
尽管重建方式似乎对总体并发症发生率没有影响，但它确实显著影响术后并发症的严重程度，主要和小并发症分别与 IBR 和 ABR 相关。这些发现与以患者为中心的决策相关，因为它们提供了关于术后并发症的进一步细节，并解决了并发症严重程度的问题。
临床问题/证据水平：治疗性，III 级。
